IRON ASSASSIN'S DEMO DERBY
Event Timing: April 4th, 2020
Event Address: 33800 King Rd Abbotsford BC,
Contact us at 778-347-1159, Email:
Demoderby100@gmail.com
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Email address
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Your email
FIRST & LAST NAME
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Your answer
FULL ADDRESS & PHONE #
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Your answer
CLASSES COMPETING IN
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WELDED DERBY 3 PIT PASSES, FEE $225
UNWELDED DERBY 2 PIT PASSES, FEE $175
ROLLOVER STUNTS 1 PIT PASS, FEE $100
FULL SIZE TRUCK DERBY 2 PIT PASSES, FEE $125
SMALL CAR FIG 8 & TEAM DERBY 1 PIT PASS EACH DRIVER, FEE $125 (PER CAR)
VAN DERBY 1 PIT PASS, FEE $100
SMALL TRUCK DERBY 1 PIT PASS, FEE $125
ADDITIONAL PIT PASSES $25 EACH $35 DAY OF EVENT
Other:
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VEHICLE INFO (YR, MAKE, MODEL, ENGINE)
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Your answer
VEHICLE #
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Your answer
PASSENGER NAME
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Your answer
SPONSOR INFO
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Your answer
SMALL CAR TEAM MATE NAME, #, TEAM NAME
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ACCOMPLISHMENTS (TELL US ABOUT YOU)
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EMERGENCY CONTACT NAME #
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TOTAL PAYMENT: make payment by e-transfer to
demoderby100@gmail.com
, question demo, answer derby1 . CHECK PAYABLE TO LEE PEMBLE
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YOU MUST NOTE YOUR BANK CONFIRMATION # ON THIS FORM, OR MAIL CHECK TO PO Box 824 Abbotsford B.C. Canada V2T 7A2 AND INCLUDE YOUR CHECK # ON THIS FORM (BELOW NOTE PAYMENT TYPE)
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BANK E-TRANSFER CONFIRMATION # OR CHECK #
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BY REGISTERING YOU AGREE TO SEND PAYMENT ASAP, ACKNOWLEDGE TO NO MINORS UNDER 14, NO ALCOHOL OR ILLEGAL DRUGS ALLOWED IN PITS OR COMPETITION AREA
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